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BACKGROUND: The gold standard for determination of energy requirement among critically ill patients is through indirect calorimetry (IC) measurement. However, this method is not widely available, necessitating estimation through formulas. There is limited study on the validity of the formulas in our Malaysian population. This study aimed to compare the energy expenditure measured using the IC with several predictive equations among critically ill patients.
METHODS: This study was a cross-sectional study conducted on adult, critically ill patients admitted to general intensive care unit, University of Malaya Medical Centre. Subjects’ energy expenditure was measured using IC. Comparisons were made with five commonly used predictive equations: Harris-Benedict (HBE), Mifflin St Jeor (MSJ), Ireton-Jones, Penn-State (PSU) equations and quick method to estimate the energy requirement of the patients.
RESULTS: IC measurement for male (n=46) was higher than female (n=25) (1752.67±474.99 kcal/day vs. 1388.12±241.48 kcal/day, p<0.001). Six predictive equations that have 1) fair agreement with IC and 2) equal variance were MSJ (ICC= 0.563, r=0.586, p=0.055), HBE x stress factor (ICC= 0.547, r=0.572, p=0.556), HBE x 1.25 (ICC= 0.541, r=0.592, p=0.957), PSU(Mifflin) (ICC= 0.529, r=0.073, p=0.842), MSJ x stress factor (ICC= 0.509, r=0.547, p=0.458) and MSJ x 1.25 (ICC= 0.490, r=0.586, p=0.727).
CONCLUSION: There were six predictive equations that have fair agreement with the IC measurement on our subjects. Mifflin St Jeor equation showed the highest correlation in estimating REE of critically ill patients.
Keywords- energy expenditure, indirect calorimetry, predictive equations